MSK Malignancy

Question 1

PS - Metastatic bone disesae (8)

Answer 1

Unremitting dull pain 
Worse at night and doesn't change on position 
Sharp upon weight bearing 
Normally comes up quite quickly 
Hypercalcaemia 
Pathological # 
B Sx
Sx of SC compression

Question 2

O/E - metastatic bone disease (3)

Answer 2

Bone tenderness
Decreased range of movement
Local lymphadenopathy

Question 3

Common sites 1’ tumours to the bones (5)

Answer 3

BLT KP
Breast 
Lung 
Thyroid 
Kidney
Prostate

Question 4

DDx mets bone (3)

Answer 4

Multiple myeloma
Lymphoma
Osteomyelitis

Question 5

Ix suspected bone mets (5)

Answer 5

Skeletal radioisotope scans - mets = hot areas 
Skeletal XR - sclerotic/lytic lesions 
CT/MRI 
CT biopsy 
Bloods

Question 6

‘Bad’ XR features suggesting malignancy (5)

Answer 6

Wide zone transition 
Permeative margin 
Interruppted periosteal reaction 
Cortical destruction 
Lytic

Question 7

Mx bone pain in mets (5)

Answer 7

Establish 1' diagnosis 
Analgesia/local radiotherapy to control
Bisphosphonates - decrease fracture risk 
Chemo/hormone therapy = breast/prostate 
Prophylactic surgery - stabilise joints

Question 8

What is multiple myeloma

Answer 8

Haem condition of plasma cell proliferation

Question 9

PS multiple myeloma (CRABBI)

Answer 9

Ca - hypercalcaemia --> constipation, nausea, confusion 
R - renal (dehydration/thirst, CKD) 
Anaemia 
Bleeding 
Bone destruction - patho #
Infection

Question 10

Ix multiple myeloma

Answer 10

FBC/U+E
Se/urine electrophoresis - Incr IgA/C protein (bence/jones protein)
Bone marrow aspiration

Question 11

Mx multiple myeloma (3)

Answer 11

Radiotherapy

Spinal decompression + fusion if necess

Question 12

Type of 1’ bone tumours (3)

Answer 12

Osteosarcoma
Chrondrosarcoma
Osteoma

Question 13

What is an osteosarcoma

Answer 13

Malignant tumour of osteoblasts

Question 14

Prognosis osteosarcoma

Answer 14

5y 10%

Question 15

Who gets osteosarcomas

Answer 15

Children

Question 16

Which bone is most affected by osteosarcoma

Answer 16

KNee

Question 17

Which other condition is osteosarcoma associated with?

Answer 17

Paget’s disease

Question 18

Where does osteosarcoma mets to?

Answer 18

Lung

Question 19

What is chondrosarcoma

Answer 19

Malignant cartilage forming lesion

Question 20

Growth - chondrosarcoma

Answer 20

slow

Question 21

Who gets chondrosarcomas

Answer 21

Adults

Question 22

Where are chondrosarcomas most commonly?

Answer 22

pelvis

Question 23

PS 1’ bone tumours (3)

Answer 23

Pain
Mechanical Sx
Pathological #

Question 24

Mx 1’ bone tumours aims

Answer 24

1’ - survival

2’ - limb preservation

Question 25

Mx 1’ bone tumour

Answer 25

En-bloc resection + adjuvant chemo/radiotherapy